The diagnostic dilemma of pathological appearance and performance enhancing drug use

Abstract

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolicandrogenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

The influence of age of onset and acute anabolic steroid exposure on cognitive performance, impulsivity, and aggression in men.

“…Men from the original sample (N =71) described by Hildebrandt, Langenbucher, Lai, Loeb, and Hollander (2011) were included in this study and a subset of ( n = 22) were used to test hypotheses about cognition. We recruited current (on-cycle or plans to go on-cycle in the next year) experienced (>1 AAS cycle) AAS users primarily from local gyms and newspaper adds.…”

“…As reported in Hildebrandt, Langenbucher, et al., (2011), all clinical interviews were completed by trained research staff and co-rated by blind co-raters and reached high levels of inter-rater and test-retest reliability. The Structured Clinical Interview of Diagnosis (SCID-I; (First, Spitzer, Gibbon, & Williams, 2007) was used to assess for AAS dependence and comorbid SUDs.…”

“…The Structured Clinical Interview of Diagnosis (SCID-I; (First, Spitzer, Gibbon, & Williams, 2007) was used to assess for AAS dependence and comorbid SUDs. The Appearance and Performance Enhancing Drug Use Schedule (APEDUS) , as described by Hildebrandt, Langenbucher, et al, (2011), is a semi-structured interview that includes 10 modules providing a comprehensive assessment of APED use and associated phenomena. For this sub-sample, inter-rater reliability was high for individual items and scales ranging from κ = .94 to 1.0.…”

Dismorfia Muscular: detección del uso-abuso de esteroides anabolizantes androgénicos en una muestra española

“…Los EAA (Hildebrandt et al, 2011) más usados por los hombres que admitieron su uso ocasional o continuo fueron Deca-Durabolin (78%) y Dianabol (22%), y los más usados por las mujeres eran Androgel (47%), Dianabol (33%) y Deca-Durabolin (20%).…”

Orientación Sexual y el Uso de Anabólicos Esteroideos en jóvenes varones Latinoamericanos entre 18 y 30 años

“…Estos fueron definidos para los participantes con el enunciado: "Para este estudio, los anabólicos esteroideos serán considerados como aquellas sustancias inyectables o en pastillas/cápsulas que son derivados de hormonas masculinas (como la testosterona, estanozolol, oxandrolona, metanolona, metandrostenolona, boldenona, nandrolona, polysetron, entre otros.) y son usadas principalmente para incrementar la masa muscular" (17). Esta se midió con la pregunta "¿Utiliza o ha utilizado alguna vez anabólicos esteroideos sin la prescripción de un médico?"…”